Bad weekend sets up rough week for health bill; despite echoes of optimism

President Barack Obama and Senate Majority Leader Harry Reid remain optimistic the Senate can wrap up the healthcare overhaul in time for Christmas, but few signs suggest that package will be ready in 2009.
 
“I think it's going to pass out of the Senate before Christmas,” Obama said during an interview aired Sunday on CBS News’s “60 Minutes.”
 

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The Senate will pick up the debate this week after taking a break to pass a spending bill to keep the government running.
 
But Reid (D-Nev.) will have to find a way to get 60 votes with Republicans united against the bill and members of his own party coming out against the bill.
 
Two key centrists, Sens. Joe Lieberman (I-Conn.) and Ben Nelson (D-Neb.), made clear over the weekend that they won’t support the latest version of the healthcare legislation.
 
Democrats are squabbling among themselves over promises the White House made to win the support of the pharmaceutical industry for reform.
 
In addition, the Congressional Budget Office (CBO) on Sunday issued a harsh assessment of a proposal to mandate health insurance companies spend at least 90 percent of their premium income on medical claims. Such a requirement, the CBO concluded, would devastate the industry.
 
Liberals in the Senate are feeling the leverage applied by a handful of centrists.
 
“The reason it's so difficult is because every single Democrat and independent has to vote for it,” Sen. Jay Rockefeller (D-W.Va.) said on CBS News’s “Face the Nation” Sunday. “I think, the closer you get, the more you have to look at the whole bill, the more likely you are to say, 'I have to do this for the nation.'”
 
Reid and the 10 senators who forged the tentative agreement, along with most of the other 50 senators in the Democratic Conference, stressed last week that skeptical lawmakers would await a CBO cost estimate before stating their positions on the bill.
 
But with the CBO still at least a few days from completing its work, Lieberman decided he did not have to wait any longer.
 
Lieberman sharply criticized a proposal to allow people between 55 and 64 to buy into the Medicare program and the significantly scaled-down “trigger” version of the government-run health insurance program, which would only be opened if the private market failed to provide adequate coverage. Both are important to liberals.
 
“I certainly would have a hard time voting for it because it has some of the same infirmities that the public option did,” Lieberman said on “Face the Nation." “It will add taxpayer costs. It will add to the deficit. It's unnecessary.”

According to various news accounts, Lieberman repeated his vow to oppose the bill in a private meeting with Reid later Sunday.

Nelson also criticized the Medicare buy-in proposal, despite participating in talks that produced it.

“It's the forerunner of single-payer, the ultimate single-payer plan, maybe even more directly than the public option,” he said.

The Senate began debating a prescription drug “reimportation” amendment by Byron Dorgan (D-N.D.) last Tuesday and has yet to vote. Part of the delay is the result of GOP leadership not agreeing to a speedy vote.

But also to blame is a deal between the White House and the Pharmaceutical Research and Manufacturers of America (PhRMA), which strongly opposes the reimportation amendment. PhRMA has been supportive of the healthcare reform effort this year and the White House promised to limit its financial exposure to $80 billion over 10 years.

Supporters of the Dorgan amendment strongly hinted last week they would be willing to lose out in exchange for a bigger priority: narrowing or closing the so-called donut hole in the Medicare Part D prescription drug benefit. The donut hole affects beneficiaries whose drug costs reach $2,700 in a year, after which they must pay full price for their drugs until the spending surpasses $6,100, when their benefit kicks back in.

“The issue is: What is the best possible outcome with all the different things we need to do?” Sen. Charles Schumer (D-N.Y.) said Friday. “Some [senators] mention filling the donut hole, some mention getting prices lower, some mention safety. You have to just sort of put it all together.”

The CBO on Sunday issued a strongly worded memo on the proposal establishing all health insurance companies’ “medical-loss” ratio at a maximum of 10 percent — meaning 90 percent of premiums would have to go to medical claims. Companies would have to issue rebates to their customers if they fail to meet this standard. Alternatives would set the level at 80 percent to 85 percent, as included in the House-passed healthcare bill.

Considering the medical-loss ratio in tandem with the other strict new insurance regulations contained in the bill, the CBO predicted that such a policy would “reduce the types, range of prices, and number of private-sector sellers of health insurance,” the memo says.

“In CBO’s view, this further expansion of the federal government’s role in the health insurance market would make such insurance an essentially governmental program, so that all payments related to health insurance policies should be recorded as cash flows in the federal budget,” the memo states.